1. Mechanisms that Produce a Stroke
Blockage of an artery (80% of strokes)
--causes ischemia (inadequate blood flow) This
deprives the brain of oxygen and glucose, and
slows waste removal
--affected brain tissue functions abnormally or stops
functioning, and will die if ischemia persists
Rupture of an artery (20% of strokes)
--causes hemorrhage within or around the brain. This
distorts, compresses, and tears surrounding tissue
ventricle
Lumen

2. Stroke Risk Factors
Relationship to pathology
Directly or indirectly promote conditions that ‘encourage’ blockage or rupture of arteries supplying the brain:
ventricle
Development of atherosclerotic plaque
Thrombus formation in heart or cerebral arteries
Physical stress and direct damage to walls of
large and small arteries
Lumen

3. Stroke Risk Factors Hypertension Heart Disease Diabetes Mellitus
Behaviors / Lifestyles
‘Who We Are’
Medical Conditions
(treatable/controllable)
Hypertension
Heart Disease
Myocardial Infarction
Atrial Fibrillation
Diabetes Mellitus
Hyperlipidemia
Carotid Stenosis
Cigarette Smoking
Physical Inactivity
Excess Alcohol Use
Obesity
Age
Gender
Race/Ethnicity
Family History
Prior Stroke/TIA
ventricle
Lumen

4. Stroke Risk Factors Behaviors or Lifestyles Cigarette Smoking
Increases risk about 1.5X
The heavier the smoking, the greater the risk
5 years after quitting, risk matches that for nonsmokers
Physical Inactivity
Sedentary lifestyle is independent risk factor
(30 min. moderate-to-vigorous daily exercise recommended)
Excessive Alcohol Consumption
≥ 5 drinks/day and binge drinking
Obesity
Body mass index ≥ 30 doubles risk
ventricle
Lumen

5. Stroke Risk Factors Medical conditions: treatable or controllable
Hypertension
Blood pressure ≥ 140/90 mm Hg for extended periods
Heart Disease
Myocardial Infarction
Atrial Fibrillation
Diabetes Mellitus
Fasting plasma glucose ≥ 126 mg/dL
Hyperlipidemia
Total cholesterol ≥ 240 mg/dL accelerates atherosclerosis
Carotid Artery Stenosis
≥ 70% narrowing of the carotid artery in the neck
Hypertension is the most significant treatable risk factor!
increase risk of thrombus formation
in heart, and thus embolic strokes
ventricle

6. Stroke Risk Factors Unmodifiable conditions: ‘Who we are’ Age
Risk of stroke doubles every 10 years after age 55
Gender
Women’s first strokes occur when they are older
Race/Ethnicity
African-Americans 60% more likely to have a stroke,
and twice as likely to die compared to other groups
Family History
First-degree relative with stroke
Inherited defects influencing blood clotting
Previous Stroke or TIA
1:6 ischemic stroke survivors has another stroke in 2 yrs
Having a TIA increases the chances of stroke 10 times
ventricle
Lumen

7. atherosclerotic plaque narrows lumen ( )
Basilar Artery
atherosclerotic plaque narrows lumen ( )
plaque

8. Aorta - Atherosclerosis Numerous ulcerated plaques

9. atherosclerotic plaque and thrombus
Carotid Bifurcation
atherosclerotic plaque and thrombus
Thrombus on
plaque surface
plaque
Thrombus on
plaque surface

10. Embolus Plugging Artery
Piece of thrombus that traveled from heart
Arterial wall
ventricle
Lumen
Plugged lumen

11. Intracerebral Hemorrhage
ventricle
Lumen
Clotted
blood

12. Intracerebral Hemorrhage
CT Scan - 3 Hours after onset of symptoms
ventricles